Chamberlain NR 449 Nursing Home Antimicrobial Stewardship Programs Thesis Paper

Chamberlain NR 449 Nursing Home Antimicrobial Stewardship Programs Thesis Paper ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Chamberlain NR 449 Nursing Home Antimicrobial Stewardship Programs Thesis Paper The rubric, matrix table, and the articles are attached below. Please note: You should only use these articles, and both are quantitative studies . Chamberlain NR 449 Nursing Home Antimicrobial Stewardship Programs Thesis Paper Assigned Topic : Nursing Home Antimicrobial Stewardship Article 1: Effectiveness of interventions targeting antibiotic use in long-term aged care facilities: a systematic review and meta-analysis Article 2 : Implementing Antimicrobial Stewardship in Long-term Care Settings: An Integrative Review Using a Human Factors Approach . What should be included: Describe the problem: 1. What is the focus of your group’s work? 2. Significance of problem: What health outcomes result from your problem? Or what statistics document this is a problem? You may find support on websites for government or professional organizations. 3. Purpose of the paper: What will your paper do or describe? Categorize items in the Matrix Table, including proper intext citations and reference list entries for each article. 1. References (recent publication within the last 5 years) 2. Purpose/Hypothesis/Study Question(s) 3. Variables: Independent (I) and Dependent (D) 4. Study Design 5. Sample Size and Selection 6. Data Collection Methods 7. Major Findings (Evidence ) Describe the data in the Matrix Table, including proper intext citations and reference list entries for each article . 1. Compare and contrast variables within each study. 2. What are the study design and procedures used in each study; qualitative, quantitative, or mixed method study, levels of confidence in each study, etc.? 3. Participant demographics and information. 4. Instruments used, including reliability and validity. 5. How do the research findings provide evidence to support your clinical problem, or what further evidence is needed to answer your question? 6. Next steps: Identify two questions that can help guide the group’s work. Chamberlain NR 449 Nursing Home Antimicrobial Stewardship Programs Thesis Paper Conclusion: Review major findings in a summary paragraph. 1. Evidence to address your clinical problem. 2. Make a connection back to all the included sections. 3. Wrap up the assignment and give the reader something to think about. nr449_rua_analyzing_published_research_sept20_v2.pdf article_2.pdf article_1.pdf article_2.pdf nr449_matrix_table_v4.docx NR449 Evidence-Based Practice RUA: Analyzing Published Research Guidelines Purpose The purpose of this paper is to interpret the two articles identified as most important to the group topic. Course outcomes: This assignment enables the student to meet the following course outcomes. CO 2: Apply research principles to the interpretation of the content of published research studies. (POs 4 and 8) CO 4: Evaluate published nursing research for credibility and clinical significance related to evidence-based practice. (POs 4 and 8) Due date: Your faculty member will inform you when this assignment is due. The Late Assignment Policy applies to this assignment. Total points possible: 200 points Preparing the assignment 1. Follow these guidelines when completing this assignment. Speak with your faculty member if you have questions. 2. Please make sure you do not duplicate articles within your group. 3. The paper will include the following: a. Clinical Question (30 points/15%) 1. Describe the problem: What is the focus of your group’s work? 2. Significance of problem: What health outcomes result from your problem? Or what statistics document this is a problem? You may find support on websites for government or professional organizations. 3. Purpose of the paper: What will your paper do or describe? ***Please note that although most of these questions are the same as you addressed in paper 1, the purpose of this paper is different. You can use your paper 1 for items 1 & 2 above, including any faculty suggestions for improvement provided as feedback. b. Evidence Matrix Table: Data Summary (Appendix A) – (60 points/30%) Categorize items in the Matrix Table, including proper intext citations and reference list entries for each article. 1. References (recent publication within the last 5 years) 2. Purpose/Hypothesis/Study Question(s) 3. Variables: Independent (I) and Dependent (D) 4. Study Design 5. Sample Size and Selection 6. Data Collection Methods 7. Major Findings (Evidence) c. Description of Findings (60 points/30%) Describe the data in the Matrix Table, including proper intext citations and reference list entries for each article. 1. Compare and contrast variables within each study. 2. What are the study design and procedures used in each study; qualitative, quantitative, or mixed method study, levels of confidence in each study, etc.? 3. Participant demographics and information. 4. Instruments used, including reliability and validity. 5. How do the research findings provide evidence to support your clinical problem, or what further evidence is needed to answer your question? 6. Next steps: Identify two questions that can help guide the group’s work. d. Conclusion (20 points/10%) Review major findings in a summary paragraph. Chamberlain NR 449 Nursing Home Antimicrobial Stewardship Programs Thesis Paper 1. Evidence to address your clinical problem. 2. Make a connection back to all the included sections. NR449_RUA_Analyzing_Published_Research_Guidelines_Sept20_v2 1 NR449 Evidence-Based Practice RUA: Analyzing Published Research Guidelines 3. Wrap up the assignment and give the reader something to think about. e. Format (30 points/15%) 1. Correct grammar and spelling 2. Include a title and reference page 3. Use of headings for each section: o Problem o Synthesis of the Literature ? Variables ? Methods ? Participants ? Instruments ? Implications for Future Work 4. Conclusion 5. Adheres to current APA formatting and guidelines 6. Include at least two (2) scholarly, current (within 5 years) primary sources other than the textbook 7. 3-4 pages in length, excluding appendices, title and reference pages For writing assistance (APA, formatting, or grammar) visit the APA Citation and Writing page in the online library. Please note that your instructor may provide you with additional assessments in any form to determine that you fully understand the concepts learned. 2 NR449_RUA_Analyzing_Published_Research_Guidelines_Sept20_v2 2 NR449 Evidence-Based Practice RUA: Analyzing Published Research Guidelines Grading Rubric Criteria are met when the student’s application of knowledge demonstrates achievement of the outcomes for this assignment. Assignment Section and Required Criteria (Points possible/% of total points available) Clinical Question (30 points/15%) 1. 2. 3. Required criteria Describe the problem: What is the focus of your group’s work? Significance of problem: What health outcomes result from your problem? Or what statistics document this is a problem? You may find support on websites for government or professional organizations. Purpose of the paper: What will your paper do or describe? Evidence Matrix Table: Data Summary (Appendix A) (60 points/30%) Highest Level of Performance High Level of Performance Satisfactory Level of Performance Unsatisfactory Level of Performance Section not present in paper 30 points 26 points 24 points 11 points 0 points Includes 3 Includes 2 Includes 1 requirements for requirements for requirement for section. section. section. 60 points 56 points 47 points Present, yet includes no required criteria. 25 points No requirements for this section presented. 0 points Required criteria Includes 7 Includes 6 Includes 5 Includes 4 or less No requirements Categorize items in the Matrix Table, including proper intext citations and requirements for requirements for requirements for requirements for for this section reference list entries for each article. section. section. section. presented. section. 1. References (recent publication within the last 5 years) 2. Purpose/Hypothesis/Study Question(s) 3. Variables: Independent (I) and Dependent (D) 4. Study Design 5. Sample Size and Selection 6. Data Collection Methods 7. Major Findings (Evidence) Description of Findings (60 points/30%) 60 points 53 points 47 points 23 points 0 points Required criteria Includes 6 Includes 5 Includes 4 Includes 3 or less No requirements Describe the data in the Matrix Table, including proper intext citations requirements for requirements for requirements for requirements for for this section and reference list entries for each article. section. section. section. section. presented. Chamberlain NR 449 Nursing Home Antimicrobial Stewardship Programs Thesis Paper 1. Compare and contrast variables within each study. 2. What are the study design and procedures used in each study; qualitative, quantitative, or mixed method study, levels of confidence in each study, etc.? 3. Participant demographics and information. NR449_RUA_Analyzing_Published_Research_Guidelines_Sept20_v2 3 NR449 Evidence-Based Practice RUA: Analyzing Published Research Guidelines Assignment Section and Required Criteria (Points possible/% of total points available) 4. 5. 6. Required criteria Review major findings in a summary paragraph. 1. Evidence to address your clinical problem. 2. Make a connection back to all the included sections. 3. Wrap up the assignment and give the reader something to think about. Format (30 points/15%) 4. 5. 6. 7. High Level of Performance Satisfactory Level of Performance Unsatisfactory Level of Performance Section not present in paper 20 points 18 points 15 points 8 points 0 points Present, yet includes no required criteria. No requirements for this section presented. Instruments used, including reliability and validity. How do the research findings provide evidence to support your clinical problem, or what further evidence is needed to answer your question? Next steps: Identify two questions that can help guide the group’s work. Conclusion (20 points/10%) 1. 2. 3. Highest Level of Performance Includes 3 Includes 2 Includes 1 requirements for requirements for requirement for section. section. section. 30 points Required criteria Correct grammar and spelling Include a title and reference page Use of headings for each section: o Problem o Synthesis of the Literature ? Variables ? Methods ? Participants ? Instruments ? Implications for Future Work Conclusion Adheres to current APA formatting and guidelines Includes at least two (2) scholarly, current (within 5 years) primary sources other than the textbook 3-4 pages in length excluding appendices, title and reference pages 26 points 23 points 11 points 0 points Includes 8 Includes 7 Includes 6 Includes 5 or less No requirements requirements for requirements for requirements for requirements for for this section section. section. section. section. presented. Total Points Possible = 200 points NR449_RUA_Analyzing_Published_Research_Guidelines_Sept20_v2 4 NR449 Evidence-Based Practice RUA: Analyzing Published Research Guidelines Appendix A EVIDENCE MATRIX TABLE Article References 1 (SAMPLE ARTICLE) Smith, L. (2013). What should I eat? A focus for those living with diabetes. Journal of Nursing Education, 1(4), 111-112. Purpose Hypothesis Study Question(s) How do educational support groups effect dietary modifications in patients with diabetes? Variables Independent(I) Dependent(D) D-Dietary modifications I-Education Study Design Quantitative Sample Size & Selection Data Collection Methods N- 18 Convenience sample-selected from local support group in Pittsburgh, PA Focus Groups Major Finding(s) Support and education improved compliance with dietary modifications. 1 2 3 4 5 NR449_RUA_Analyzing_Published_Research_Guidelines_Sept20_v2 5 Clinical Infectious Diseases INVITED ARTICLE HEALTHCARE EPIDEMIOLOGY: Robert A. Weinstein, Section Editor Implementing Antimicrobial Stewardship in Long-term Care Settings: An Integrative Review Using a Human Factors Approach Morgan J. Katz,1 Ayse P. Gurses,2 Pranita D. Tamma,3 Sara E. Cosgrove,1 Melissa A. Miller,4 and Robin L. P. Jump5,Chamberlain NR 449 Nursing Home Antimicrobial Stewardship Programs Thesis Paper 6 1 Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, 2Armstrong Institute for Patient Safety and Quality, School of Medicine, Bloomberg School of Public Health, Whiting School of Engineering, and 3Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, and 4Division of Healthcare-Associated Infections, Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, Maryland; and 5Geriatric Research Education and Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, and 6Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University, Cleveland, Ohio In September 2014, the Obama Administration issued the Executive Order “Combating Antibiotic-Resistant Bacteria” [1], prompting the Centers for Medicare and Medicaid Services (CMS) to propose regulatory changes that will require antimicrobial stewardship activities in long-term care facilities (LTCFs) [2]. LTCFs include several settings that provide skilled nursing and residential care, such as long-term acute care hospitals (LTACHs), assisted living, home healthcare, and nursing homes. Recent reviews of this topic indicate that the antimicrobial stewardship interventions described in the literature are multimodal and generally incorporate a structured educational component [3–5]. They also call for further research to identify effective implementation strategies [3–5]. Effective antimicrobial stewardship requires complex and interdisciplinary interventions that address both people and healthcare systems in which they work. The Systems Engineering Initiative for Patient Safety (SEIPS) is a human factors model that uses an engineering approach to patient safety by guiding Received 22 February 2017; editorial decision 13 June 2017; accepted 20 June 2017; published online June 20, 2017. Correspondence: M. J. Katz, Johns Hopkins University Hospital, 1830 E Monument St, Baltimore, MD 21287 ([email protected]). ® Clinical Infectious Diseases ??2017;65(11):1943–51 © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected] DOI: 10.1093/cid/cix566 work system redesign and improvement efforts [6]. Human factors engineers consider complex work systems, applying their knowledge of human limitations and abilities to reduce the safety risks to patients due to human error and to improve the overall work system in which care is provided [7, 8]. The SEIPS model proposes that the following 5 work system components continuously interact and influence one another: tools and technologies, tasks, organizational conditions, person(s), and the physical environment (Table 1) [6]. Changes to any or multiple aspects of these components may either positively or negatively affect the resulting processes, and therefore patient, professional, or organizational outcomes. Hence, this model can be useful to organizations developing and implementing an antimicrobial stewardship intervention by considering the complex and dynamic nature of LTCFs and contextual factors unique to that healthcare setting.Here, we use an integrative literature review to analyze antimicrobial stewardship interventions in LTCFs within the framework of a human factors engineering approach to identify those aspects of multimodal interventions most likely to support effective implementation. METHODS Using integrative review methodology [9], we searched PubMed for peer-reviewed medical literature describing antimicrobial stewardship interventions in LTCFs. Iterative searching of HEALTHCARE EPIDEMIOLOGY • CID 2017:65 (1 December) • 1943 Downloaded from Chamberlain NR 449 Nursing Home Antimicrobial Stewardship Programs Thesis Paper https://academic.oup.com/cid/article/65/11/1943/3873532 by guest on 27 November 2020 Implementing effective antimicrobial stewardship in long-term care facilities (LTCFs) is associated with challenges distinct from those faced by hospitals. LTCFs generally care for elderly populations who are vulnerable to infection, have prescribers who are often off-site, and have limited access to timely diagnostic testing. Identification of feasible interventions in LTCFs is important, particularly given the new requirement for stewardship programs by the Centers for Medicare and Medicaid Services (CMS). In this integrative review, we analyzed published evidence in the context of a human factors engineering approach as well as educational interventions to understand aspects of multimodal interventions associated with the implementation of successful stewardship programs in LTCFs. The outcomes indicate that effective antimicrobial stewardship in long-term care is supported by incorporating multidisciplinary education, tools integrated into the workflow of nurses and prescribers that facilitate review of antibiotic use, and involvement of infectious disease consultants. Keywords. antimicrobial stewardship; nursing home; long-term care; human factors; elderly. Table 1. Description of 5 Work System Components in the Systems Engineering Initiative for Patient Safety Model Work System Component Description Examples Tools and technologies Objects that individuals use to carry out their work – Alert on an electronic health record – Pocket card describing antibiotic prescribing guidelines Tasks Specific actions within a larger work process – Act of administering a medication – Checklist of antibiotic monitoring criteria that must be filled out by a pharmacist daily prior to distributing medications Organization Structures put in place to organize time, space, or resources; cultural infrastructure of the facility or communication between individuals. – Incentive program for following antibiotic prescribing guidelines – Support from stakeholders for promotion of antibiotic stewardship program Person(s) Individual characteristics of those involved in the work system – Knowledge, expertise, or training of nursing home staff Environment Physical internal or external environment where the work is done. – Physical placement of an educational poster in a common work area RESULTS The search strategy identified 86 potential studies. Subsequent screening of abstracts narrowed this to 11 potentially eligible studies. Examining the bibliographies of included studies, 1944 • CID 2017:65 (1 December) • HEALTHCARE EPIDEMIOLOGY we found 9 additional studies that met our inclusion criteria. Five (25%) studies were randomized controlled trials, and the remaining 15 (75%) were quasi-experimental analyses (Tables 2 and 3). Educational Interventions Sixteen (80%) studies incorporated a structured educational element as part of their antimicrobial stewardship intervention, 14 of which included nurses. v For 7 studies, the primary intervention was education, coupled with feedback, to prescribers and staff. Pettersson et al [17] conducted a randomized controlled trial of 58 nursing homes in Sweden in which they applied a quality improvement framework to develop their educational material, holding focus groups with physicians, nurses, and nursing assistants. The intervention consisted primarily of education, including training on guidelines for treating infections common to nursing homes, as well as feedback about each nursing home’s baseline characteristics. Although the primary outcome—the proportion of quinolones prescribed for urinary tract infections—did not change, the overall proportion of antibiotics prescribed decreased and the rate of adverse events did not increase. Schwartz et al, in a quasi-experimental study at a single hospital-based long-term care setting, compared local infection management practices to those of published guidelines in interactive sessions and also issued pocket guides [14]. They achieved a decrease in total antimicrobial use that was sustained for 2 years following the intervention. Other studies provided individualized feedback to prescribers. Using a cluster randomized controlled trial involving 36 physicians from 8 nursing homes near Montreal, Monette et al mailed an antibiotic prescribing guide to all providers [15]. Those in the experimental group also received an individualized prescribing profile describing their recent antibiotic prescriptions as adherent or nonadherent to the guide. Compared to the control group, physicians in the experimental group were less likely to write nonadherent antibiotic prescriptions. Zimmerman et al introduced a comprehensive quality improvement program that involved training sessions for nursing staff Downloaded from https://academic.oup.com/cid/article/65/11/1943/3873532 by guest on 27 November 2020 the identified publications and their references informed the final search terms (Supplementary Appendix 1). Two authors (M. J. K., R. L. P. J.) independently reviewed all titles and abstracts. Inclusion criteria were primary research studies published in English that described antimicrobial stewardship interventions in LTCFs (skilled nursing facilities, nursing homes, or LTACHs) and that used quantitative outcome measures. Exclusion criteria were studies based in ambulatory or acute care facilities, those that did not include an antimicrobial stewardship intervention, or those that did not use quantitative measures to assess outcomes. Studies determined to be possibly eligible based on the title and abstract were included for full text review for final assessment of inclusion and exclusion criteria. The same reviewers examined the bibliographies of the included studies as well as the review articles selected in the initial literature search. Data evaluation considered the study design, focus on a specific infectious syndrome (eg, urinary tract infection or pneumonia), and quantitative outcome measures. Quality assessment was performed using established quality assessment tools [10]. Two authors (M. J. K., R. L. P. J.) independently assessed risk of bias using these tools and studies assigned a grade of “good,” “fair,” or “poor”; discrepancies were discussed and agreed upon by each author. We used the SEIPS model, which includes 5 work system components, to guide our analysis (Table 1), classifying each … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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